Combination Of Assessment Methods Research Articles

Understanding the Risk of Dysphagia in Daytime Rehabilitation Services and Combination of Assessment Methods Using Screening for Dysphagia

Understanding the Risk of Dysphagia in Daytime Rehabilitation Services and Combination of Assessment Methods Using Screening for Dysphagia

Changes in Motor Skills, Sensory Profiles, and Cognition Drive Food Selection in Older Adults With Preclinical Dysphagia.

Purpose Self-selection and self-avoidance of certain foods is one possible indicator of preclinical (prior to any clinical intervention) dysphagia in healthy older adults. Self-selection of food choices is influenced by changes in a combination of factors, including neuromuscular, sensory, and individual patient characteristics. Changes to these factors occur both centrally or peripherally and can be part of typical, healthy aging. Alterations in motor, sensory, or cognitive skills may lead to self-imposed modifications to food choices and, therefore, highlight potential risk for dysphagia. Conclusions For effective screening and assessments procedures in healthy aging adults, the diagnosis of preclinical dysphagia will likely require a multifaceted assessment. A combination of assessment methods using objective and subjective measurements of neuromuscular, sensory, and individual patient factors, as well as knowledge of food avoidance, may provide insight for identifying community-dwelling older adults at risk for dysphagia and allow for earlier monitoring and intervention.

Methods Used to Assess Student Performance and Course Outcomes atthe National Center of Excellence inDairy Production Medicine Education for Veterinarians.

Between 2012 and 2014, three cohorts of senior veterinary students participated in an 8-week dairy production medicine course created by the National Center of Excellence in Dairy Production Medicine Education for Veterinarians. One goal of this course is to better prepare veterinary students to serve the increasingly complex needs of the dairy industry. In this article, we describe the assessment methods and student performance outcomes of those first three cohorts. A combination of assessment methods was used, including pre- and post-testing; instructor observations and scores on individual and group projects, including a final integrative project; and peer evaluation. Student feedback, collected via anonymous survey, provided insight into students' perceptions about the course and their learning. Performance and feedback suggest that the course was successful in preparing students for careers using skills in dairy production medicine. Pre- and post-testing was conducted for most topic modules in the course. The mean (median) pre- and post-test scores were 47% (50% ) and 83% (88%), respectively. The mean improvement in score was significant (p < .002) for all modules and cohorts. Students indicated a moderate or high degree of confidence in performing dairy production medicine skills after each module. Of students in cohorts 1, 2, and 3, respectively, 55%, 75%, and 82% felt they could provide dairy production medicine services (e.g., records analysis, problem investigation, protocol and standard operating procedure design) either alone or with some mentoring, immediately after graduation. In addition, assessment results and student feedback enabled timely course modifications during these first three cohorts.

Core principles of assessment in competency-based medical education

The meaningful assessment of competence is critical for the implementation of effective competency-based medical education (CBME). Timely ongoing assessments are needed along with comprehensive periodic reviews to ensure that trainees continue to progress. New approaches are needed to optimize the use of multiple assessors and assessments; to synthesize the data collected from multiple assessors and multiple types of assessments; to develop faculty competence in assessment; and to ensure that relationships between the givers and receivers of feedback are appropriate. This paper describes the core principles of assessment for learning and assessment of learning. It addresses several ways to ensure the effectiveness of assessment programs, including using the right combination of assessment methods and conducting careful assessor selection and training. It provides a reconceptualization of the role of psychometrics and articulates the importance of a group process in determining trainees’ progress. In addition, it notes that, to reach its potential as a driver in trainee development, quality care, and patient safety, CBME requires effective information management and documentation as well as ongoing consideration of ways to improve the assessment system.

Assessing butanol from integrated forest biorefinery: A combined techno-economic and life cycle approach

The life cycle assessment (LCA) methodology is increasingly used to ensure environmental sustainability of emerging biofuels. However, LCA studies are usually not performed at the process design stage, when it would be more efficient to identify and control environmental aspects. Moreover, the long-term economic profitability of biofuels depends on future energy and climate policies, which are usually not considered in techno-economic feasibility studies. This paper combines the LCA method and a TIMES energy system model, to offer a simultaneous assessment of potential environmental impacts and market penetration under different energy and climate policy scenarios of emerging energy pathways. This combined approach is applied to butanol produced from pre-hydrolysate in a Canadian Kraft dissolving pulp mill. Indeed, the integration of biorefinery processes into existing pulp and paper mills has been identified as a promising avenue to maintain mills activities. It could increase and diversify revenues, keep the forestry-based communities alive, and potentially mitigate climate change by replacing fossil-based fuels or products. Results show that (1) the energy efficiency of the butanol production process is a critical aspect to consider in future design and implementation steps in order to make butanol a competitive fuel among all other alternative fuels, (2) with a 50% internal heat recovery, butanol has a role to play in the transportation sector under climate policy scenarios, and may have a lower carbon footprint than gasoline as estimated by a 2010 US EPA study, and (3) higher supply costs for feedstock might undermine the competitiveness of butanol on the medium term (2030), but probably not on the long-term (2050). This combination of assessment methods is replicable to analyze any types of emerging energy pathways in Canada and in other countries, and to help designing more sustainable forest biorefinery processes in other countries with important forest sector.

Prenucleation Self-Assembly and Chiral Discrimination Mechanisms during Solution Crystallisation of Racemic Diprophylline.

The crystallisation behaviour of (RS)-diprophylline (DPL) in two different solvents is investigated to assess the incidence of solvated pre-associations on nucleation, crystal growth and chiral discrimination. In the solvated state, Raman spectroscopy shows that dimeric associations similar to those depicted in the crystalline solid solution (ssRII) predominate in isopropanol (IPA), which may account for the systematic spontaneous nucleation of this crystal form from this solvent. By contrast, spontaneous nucleation in DMF yields the stable racemic compound RI, consistently with the distinct features of the Raman spectrum collected in this solvent. A crystal growth study of ssRII in IPA reveals that the crystal habitus is impacted by the solution enantiomeric excess; this is explained by increased competition between homo- and heterochiral pre-associations. This is supported by a molecular modelling study on the enantiomeric selectivity of the DPL crystal lattices. The combination of assessment methods on solution chemistry, nucleation and chiral discrimination provides methodological tools from which the occurrence of solid solutions can be rationalised.

Geochemical approach to assessing human impacts in Cork Oak forest soils of the MED region

Cork oak forests in the MED region are of critical social and ecological value and under stress from both environmental change and variation in management practice. This study, as part of a NATO Science for Peace project (SfP 981674), evaluated geochemical methods to assess potentially toxic element (PTE) input to field sites from Quercus suber forests in Tabarka (Tunisia) and an experimental control forest managed by ARGIS-Sardega (Italy). Surface and subsurface soil samples were collected from environmentally comparable sites in the two regions. Sites were identified with varied stand and shrub density and characterised for basic soil properties and multi element content. The data were evaluated using principle component analysis (PCA) and soil enrichment factors (SEF). Soils showed chemical variability associated with differences in parent material and the effects of biomass density. Contributions from events such as fire damage, as well as biomass, sea salt and geogenic sources can be identified, and evaluation is enhanced using a combination of assessment methods. Ultimately despite concerns for the regulation of forest activities in the study area, little direct anthropogenic impact was on soil quality.

Promoting critical thinking and collaborative working through assessment: combining patchwork text and online discussion boards

Within a globalised world that has ever changing social, economic, cultural and legal influences, higher education providers have a responsibility to equip graduates with the skills necessary to meet these demands. Pedagogic research shows that students’ motivation is often driven by assessment and therefore the challenge for programmes is to find an assessment method that both assesses and encourages the development of these diverse skills set. We propose that the use of patchwork text combined with online discussion boards can facilitate critical thinking and collaborative working. This paper aims to report on the educational benefits of this combination of assessment methods to promote higher level thinking, and details the nature of the collaboration and outcomes of the assessment, providing guidance for future practise.

The promises and pitfalls of including decadal-scale climate forcing of recruitment in groundfish stock assessment

Concurrent declines in demersal fish stock abundances and shifts in long-term average environmental conditions have been well documented in the Pacific. Management advice ignoring environmental forcing of recruitment may cause stocks to be over- or under-harvested, so it is important to consider including environmental forcing on recruitment in stock assessment models. Simulation testing is used to determine the statistical power of stock assessments to identify long-term, decadal-scale environmental forcing of recruitment and the ability to estimate management reference points when the duration of the fisheries time series is equal to or less than the period of the environmental cycle. Commonly used assessment methods generally lead to lower total type I (incorrectly rejecting the null hypothesis of no environmental impact) and type II (failing to detect an environmental impact when such a relationship exists) error rates. The promise of integrating environmental data with decadal-scale variability directly into stock assessments via the stock–recruitment relationship is outweighed by the pitfall of high type I error rates that are due to fishing-induced stock declines that coincide with directional environmental change. However, the impact of type I errors can be minimized by choosing an appropriate combination of assessment method and reference point estimators.

Driving after Brain Injury: A Clinical Model Based on a Quality Improvement Project

The question of whether a person can resume driving after acquired cognitive dysfunction is raised in primary care services and in hospital departments where patients suffering from brain injury are treated. These organizations rarely have a specialized program that evaluates driving fitness. This article describes a semi-structured and individualized model that serves as clinical guidelines for determining fitness to drive. The model is based on former research and clinical experience. It is exemplified by the procedure of forty-three individuals with congenital or acquired cognitive dysfunction due to head trauma or disease. A multidisciplinary team including medical, neuropsychological, occupational, and practical driving specialists optimised the clinical applicability of a driving assessment using quantitative and qualitative methods. The team discussions, including several professional evaluations and assessments, are considered very important for interpreting results, for understanding whether the cognitive impairments will have consequences on driving, and whether the individual can compensate for cognitive difficulties. The current way to determine a patient’s fitness to drive after cognitive dysfunction is an individually adapted combination of assessment methods that are often performed stepwise. This well-practiced evaluation process reveals that in many cases neither off-road tests nor on-road tests alone are sufficient to ensure sound decisions. To improve on these evaluations, this study concludes that a team-based consensus approach consisting of specialized national teams should be established to support primary care services in assessing fitness to drive in more complicated cases.

Liquid chromatography electrospray ionization tandem mass spectrometry analysis method for simultaneous detection of trichloroacetic acid, dichloroacetic acid, S-(1,2-dichlorovinyl)glutathione and S-(1,2-dichlorovinyl)-L-cysteine

Trichloroethylene (TCE, CAS 79-01-6) is a widely used industrial chemical, and a common environmental pollutant. TCE is a well-known carcinogen in rodents and is classified as “probably carcinogenic to humans”. Several analytical methods have been proposed for detection of TCE metabolites in biological media utilizing derivatization-free techniques; however, none of them is suitable for simultaneous detection of both oxidative metabolites and glutathione conjugates of TCE in small volume biological samples. Here, we report a new combination of methods for assessment of major TCE metabolites: dichloroacetic acid (DCA), trichloroacetic acid (TCA), S-(1,2-dichlorovinyl)-L-cysteine (DCVC), and S-(1,2-dichlorovinyl) glutathione (DCVG). First, DCA and TCA were extracted with ether. Second, the remaining aqueous fraction underwent solid phase extraction for DCVC and DCVG. Then, DCA and TCA were measured by hydrophilic interaction liquid chromatography ion exchange negative electrospray ionization tandem mass spectrometry, while DCVC and DCVG were measured by reverse phase positive electrospray ionization tandem mass spectrometry. This method was applied successfully to measure all 4 TCE metabolites in as little as 50 μl of serum from mice orally exposed to TCE (2100 mg/kg, 2 h). Serum concentrations (mean ± standard deviation) of the TCE metabolites obtained with this method are comparable or equivalent to those previously reported in the literature: DCA, 0.122 ± 0.014 nmol/ml (limit of detection: 0.01 nmol/ml); TCA, 256 ± 30 nmol/ml (0.4 nmol/ml); DCVG, 0.037 ± 0.015 nmol/ml (0.001 nmol/ml); DCVC, 0.0024 ± 0.0009 nmol/ml (0.001 nmol/ml). This method opens new opportunities to increase throughput and decrease number of animals required for mechanistic studies on TCE in rodents.

Use of Assessment Methods in Paediatrics: The Practice of Private Occupational Therapists

This study is part of a larger research project investigating the assessment practices of paediatric occupational therapists in independent practice in the United Kingdom. The focus of this paper is the identification of the assessment methods used and the factors influencing respondents' satisfaction with them. The research design was a cross-sectional descriptive survey using a postal questionnaire as the data collection tool.Out of 89 questionnaires sent, 66 (74%) were returned and 48 (54%) were deemed usable. The findings demonstrated that the respondents used a combination of assessment methods, with interviewing being used by all of them. The majority of the respondents were satisfied with the methods that they used. The most frequently mentioned factors influencing the respondents' satisfaction level were issues concerning standardised tests and the quality and quantity of the information gathered about the client.The implications for clinical practitioners include the benefits of using a combination of assessment methods and their selection after extensive clinical reasoning. Moreover, the use of interviewing is stressed and its multiple purposes are pointed out.

Influence of estimation procedure on soil organic carbon stock assessment in Flanders, Belgium

Abstract. The purpose of the study was to determine the soil organic carbon (SOC) stock for Flanders, Belgium and to evaluate various methods for assessing SOC stock. The assessment methods first determined the SOC density (C mass per unit area) for pedons in a database of soil properties, and then spatially distributed the SOC density to soil and soil/land use categories on a map. The results showed that the pedon SOC density is influenced by drainage class, texture and land use/land cover. The SOC density estimation method significantly influences results and leads to differences of up to 6% in total estimated SOC stock for Flanders. Use of various spatial distributing methods creates differences of up to 2% in total estimated SOC stock. The largest difference in SOC stock estimate between any combination of assessment methods was 7% (125.6 Tg vs 134.9 Tg). These findings emphasize the importance of complete spatial soil databases of high quality that reduce uncertainty of estimates for use in research examining the role of soils in the C cycle. The results indicate that the need for these databases is greater than the need to standardize methods to determine the spatial distribution of SOC. A map of the distribution of SOC density shows that in Flanders a large proportion of SOC is stored in sandy soils in the north of the territory.

Detection of Streptococcus mutans by PCR amplification of the spaP gene in teeth rendered caries free

Objectives: To investigate the degree of association between tactile and optical criteria as used to assess the carious status of the enameldentine junction (EDJ) during cavity preparation, assessment with a caries detector dye and detection of Streptococcus mutans using culture and polymerase chain reaction (PCR) techniques. Methods: Twenty-nine teeth, extracted within the previous 30 min, and 15 teeth prepared under rubber dam in vivo, were clinically assessed at the EDJ after the removal of evident carious tissue. Demineralisation was then assessed using a caries detector dye (1% acid red in propylene glycol; Cavex ™). A rosehead bur was used to remove tissue at the EDJ for culture and PCR analysis. Culture was carried out on a tryptone yeast cystine sucrose bacitracin selective medium, and PCR used to amplify a sequence (192 bp) of the spaP gene, which encodes the surface protein antigen I/II of S. mutans. Results: Demineralised tissue at the EDJ, as shown using the dye, was found in 52% of teeth. Removed tissue was culture and PCR positive for S. mutans in 2 and 47% of teeth, respectively. A highly significant association (77% of cases; P < 0.001) was shown between dye and PCR assessment methods. No association was found between any other combination of assessment methods. Conclusions: Culture methods may underestimate the presence of S. mutans. Removal of sufficient dye-stained tissue is therefore recommended to prevent further carious assault from residual S. mutans.

Essential obstetric care: Assessment and determinants of quality

This paper reports on a study to develop and to apply methods for measuring the quality of essential obstetric care (EOC) in health centers. Based on a Nigerian guideline and an international guideline, and in consultation with local experts in primary care obstetrics, norms were established for equipment, personnel, supplies and the process of EOC, focusing on critical tasks. A combination of assessment methods was used, including observation of tasks performed during intrapartum care; use of data from records of care kept by midwives during the period of observation; use of data from records kept by midwives in the calendar year preceding the period of observation; exit interviews with clients; and inventories of equipment and supplies. Twelve health centers in three Local Government Areas (LGAs) and 360 clients in labor were included in the study. Quality of care was measured quantitatively as a score, calculated for each task and for each delivery in the health center. The results show that the methods developed are useful for: identifying quality score differences among health centers, and the effects of methods of assessment on quality scores; identifying aspects of EOC requiring improvements within each health center; and identifying factors influencing the quality of care, as a basis for effective quality improvement efforts. Regression models show that the most consistent and important predictor of quality scores is the use of printed forms (i.e. routine records of labor) during intrapartum care. Printed forms served as job aids, providing prompts that reminded midwives to perform specific tasks.